A clinical case of early multifocal atherosclerosis complicated by acute coronary syndrome in a young man with ulcerative colitis

Abstract

Inflammatory bowel disease  (IBD) is a chronic, relapsing, systemic and immune-mediated conditiondis  that  frequently  involve extraintestinal manifestations. Latest  studies  showed  increased risk of cardiovascular  complications,  which is the  main cause of death  in developed countries, in chronic inflammatory disorders, especially during IBD relapses. IBD patients are at increased risk of conditions  such as early atherosclerosis, ischaemic heart  disease, myocardial infarction, stroke, venous thrombosis, heart failure, аtrial fibrillation. Hypotheses  for the  mechanism  underlying  the  association of IBD and atherosclerotic cardiovascular diseases  include adverse  effects of both the IBD itself (chronic inflammation, еndothelium dysfunction, dyslipidemia, thrombocytosis, gut microbiome  dysfunction) and its treatment. The predominant role in atherogenesis is currently assigned  to disruption of the endothelium. Endothelium plays an important role in physiologic regulation of vascular tone, cell adhesion, migration and resistance to thrombosis. Also, its dysfunction  is associated with increased risk of atherosclerosis development. Early multifocal atherosclerosis is a serious complication  of ulcerative  colitis and can occur in young people  without  traditional cardiovascular  risk factors. Untimely diagnosis,  lack of pathogenetic treatment, correction  of basic anti-inflammatory therapy  and comprehensive consideration of a problem  of high cardiovascular  risk can lead to acute  myocardial infarction  and stroke and disability of a patient  of working age. The authors  present a case  report  of multifocal  atherosclerosis complicated by acute coronary syndrome in a young man with ulcerative  colitis, who required  a radical revision of the therapy.